Informing the Future Critical Issues in Health, Fifth Edition (2009) / Chapter Skim
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Improving the Nation's Health Care System
Improving the Nation's Health Care System
Pages 33-52
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From page 33... ...
seeks ways to help reinvigorate the health care system every year. Studies range from crafting blueprints for major system overhauls to offering guidance for how health care professionals should provide care to patients, to studies on development of policies and technologies that reduce the effects of disabilities.
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From page 34... ...
A national push also is needed to better prepare family members and other informal caregivers to tend to older people, as well as to prepare these individuals to take more active roles in their own care. To foster such efforts, Medicare, Medicaid, and other health plans should pay more for the services of geriatric specialists and direct-care workers to attract more health professionals and to staunch turnover among care aides, many of whom earn wages below the poverty level.
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From page 35... ...
According to its sponsors, the bill "aims to expand education and training opportunities in geriatrics and long-term care for licensed health professionals, direct-care workers, and family caregivers." Both the Senate and House bills were referred to Committee in early 2009.
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From page 36... ...
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety (2009) finds consid erable scientific evidence that the amount of duty hours permitted in current resident work sched ules can result in fatigue and the chance of fatigue related medical errors, and that adjustments to the duty hour limits are needed.
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From page 37... ...
hours for transition and educational activities) • 16 hours with no protected sleep period Maximum in-hospital Every third night, Every third night, on-call frequency on average no averaging Minimum time • 10 hours after day shift 10 hours after off between shift length • 12 hours after night shift scheduled shifts • 14 hours after any extended duty period of 30 hours and not return until 6 a.m.
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From page 38... ...
, the IOM took an in-depth look at how cancer patients might be better served. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs (2007)
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From page 39... ...
As a remedy, the nation should adopt a new standard of care under which all oncology care providers would systematically screen patients for distress and other problems; connect patients with health care or service providers who have resources to meet these needs and coordinate care with these professionals; and periodically reevaluate patients to determine if any changes in care are indicated. As a guide to achieving this standard, the report recommends a set of 10 actions that should be taken by oncology providers, health policy makers, educators, health insurers, health plans, quality oversight organizations, researchers and research sponsors, and consumer advocates.
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From page 40... ...
But financial ties between mediindustry and the medical cine and industry may create conflicts of community fail to strengthen interest that put at risk the integrity of medtheir conflict-of-interest ical research, the objectivity of professional policies, practices, and education, the quality of patient care, the enforcement, more policy soundness of clinical practice guidelines, makers may turn to legislatie and the public's trust in medicine. solutions, as officials in With support from the NIH and sevsome states already hae.
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From page 41... ...
Physicians should limit their interactions with company sales representatives and use free drug samples only for patients who cannot afford medications. At a broader level, all academic medical centers, journals, professional societies, and other entities engaged in health research, education, clinical care, and development of practice guidelines should establish or strengthen conflict-of-interest policies.
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From page 42... ...
Congress; pharmaceutical, medical program for the reporting device, and biotechnology companies of company payments Medical research 4.1 Restrict participation Academic medical centers and other of researchers with conflicts research institutions; medical researchers of interest in research with human participants Medical education 5.1 Reform Academic medical centers and relationships with industry teaching hospitals; faculty, in medical education students, residents, and fellows 5.2 Provide education Academic medical centers and teaching on conflict of interest hospitals; professional societies 5.3 Reform financing Organizations that created the accrediting system for continuing program for continuing medical education medical education and other organizations interested in high-quality, objective education Medical practice 6.1 Reform financial Community physicians; professional relationships with industry societies; hospitals and other for community physicians health care providers 6.2 Reform industry Pharmaceutical, medical device, interactions with physicians and biotechnology companies
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From page 43... ...
A recent IOM report, HHS in the 21st Century: Charting a New Course for a Healthier America (2008) , described earlier in this book, suggests ways in which the U.S.
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From page 44... ...
One of the fundamental aims of comparative effectiveness research is to help doc tors avoid ineffective or more costly approaches that might not work or, worse, allow a patient's condition to deteriorate by delaying more effective treatment. The IOM report, Initial National Priorities for Comparative Effectiveness Research (2009)
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From page 45... ...
vector, editable The IOM's Board on Health Care Services, in collaboration with the National Research Council's Computer Science and Telecommunications Board, examined the cohesiveness and pace of the HHS program, focusing in particular on efforts to develop and implement operating standards. Opportunities for Coordination and Clarity to Advance the National Health Information Agenda: A Brief Assessment of the Office of the National Coordinator for Health Information Technology: A Letter Report (2007)
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From page 46... ...
These steps can help capitalize on the promise that information technology holds for improving the nation's health. exploring the prospects of integratie medicine At a time when attention has turned to health reform and the future shape of health care, many are considering the promise of "integrative medicine." Integrative medicine can be described as orienting the health care process to engage patients and caregivers in the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health.
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From page 47... ...
cial pressures on local health care delivery. reducing health disparities and promoting health literacy For many of those who do have health insurance, proper health care remains a fantasy more than reality.
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From page 48... ...
presents the experiences of health professionals and other care workers who serve on the front lines of efforts to reduce disparities in health care, as well as the experiences of researchers, policy makers, community activists, and other individuals who deal with the array of social factors that help determine a person's overall health. Based on their various experiences, some participants called for increased efforts at the national level to collect solid data about health disparities and eliminate institutional racism.
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From page 49... ...
4 Improing the Nation's Health Care System Males Females County life expectancy 1997–2001. SOURCE: Challenges and Successes in Reducing Health Disparities: Workshop Summary, p.
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From page 50... ...
explores the various steps that health professionals and others are taking to improve care delivery to today's populations and what challenges remain in assuring better health for future populations. Workshop participants, drawn from a range of fields across the health care spectrum, examined how providing patients with appropriate medications in their primary languages and offering translation services can vastly improve the health care patients receive, and they considered ways in which health care providers might integrate these seemingly separate challenges into their daily routines.
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From page 51... ...
Improing the Nation's Health Care System Largest Disparities in Health Care Quality for Selected groups: 00 Versus 00 NHDra 2005 NHDRa 2007 NHDRa Relative Relative Group Measure Rate Measure Rate Black New AIDS cases per 10.4 New AIDS cases per 10.0 100,000 population 100,000 population age 13 and over age 13 and over Hospital admissions 4.0 Hospital admissions 3.8 for pediatric for pediatric asthma per asthma per 100,000 population 100,000 population ages 2–17 ages 2–17 Percent of 1.9 Hospital admissions 3.8 patients who left for lower extremity the emergency amputations in department without patients with being seen diabetes per 100,000 population Asian Persons age 18 1.6 Composite: Adults 1.6 or older with who reported poor serious mental communication illness who did with health not receive mental providers health treatment or counseling in the past year Adults who can 1.6 Long-stay 1.5 sometimes or nursing home never get care for residents who illness or injury as were physically soon as wanted restrained Adults age 65 1.5 Adults age 65 1.5 and over who did and over who did not ever receive not ever receive pneumococcal pneumococcal vaccination vaccination AI/ANb Women not 2.1 Women not 2.1 receiving prenatal receiving prenatal care in the first care in the first trimester trimester Composite: Adults 1.8 Composite: Adults 1.8 who reported poor who reported poor communication communication with health with health providers providers continued
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From page 52... ...
b SOURCE: Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary, p.
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